Primary Prevention of Diabetes Update 2011
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Transcript of Primary Prevention of Diabetes Update 2011
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LIFE STYLE INTERVENTION
HIGHLIGHTS
DIABETES UPDATE 2011
DIABETES CARE VOLUME 34 SUPPLEMENT 1 JANUARY 2011
care.diabetesjournals.orgAmerican Diabetes AssociationPresentator : dr. Putri Adimukti, M.kes
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Current criteria for the
diagnosis of diabetes
A1C 6.5%.
fasting plasma glucose (FPG) 126 mg/dl(7.0 mmol/l), or 2-h plasma glucose 200
mg/dl (11.1 mmol/l)
in a patient with classic symptoms ofhyperglycemia or hyperglycemic crisis,
a random plasma glucose 200 mg/dl(11.1 mmol/l)
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Current criteria for the
diagnosis of diabetesPrediabetes
FPG 100125 mg/dl (5.66.9 mmol/l): IFG
or
2-h plasma glucose in the 75-g OGTT 140199mg/dl (7.811.0 mmol/l): IGT
or
A1C 5.76.4%
Notice:
FPG=Fasting Plasma Glucose
IFG=Impaired Fasting Glucose
IGT=Impaired Glucose Tolerance
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Risk Factor For Diabetes
Overweight (BMI 25 Kg/m2), with additionalfactors:
Physical inactivity
First-degree relative with diabetes
High-risk race/ethnicity (e.g., African American, Latino,Native American, Asian American, Pacific Islander)
Women who delivered a baby weighing 9 lb or werediagnosed with GDM
Hypertension (140/90 mmHg or on therapy forhypertension)
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Risk Factor For Diabetes
HDL cholesterol level 35 mg/dl (0.90 mmol/l)
Triglyceride level 250 mg/dl (2.82 mmol/l)
Women with polycystic ovarian syndrome(PCOS)
A1C 5.7%
IGT, or IFG on previous testing
Other clinical conditions associated with insulinresistance (e.g., severe obesity, acanthosisnigricans)
History of CVD
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Testing for diabetes in
asymptomatic patients
In adults of any agewho are overweight or
obese (BMI 25 kg/m2)and who have one ormore additional riskfactors for diabetes.
In those without
these risk factors,testing should begin
at age 45 years.
If tests are normal,repeat testing carriedout at least at 3-year
intervals isreasonable.
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Prevention Prediabetes To
Diabetes
Patientswith:
impairedglucosetolerance
(IGT)
impairedfasting
glucose(IFG)
A1C of5.76.4%
should bereferred
to aneffectiveongoing
supportprogram
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Support Program
weight loss of 7% of body weight
increasing physical activity to at least 150min/week of moderate activity such as walking.
Follow-up counseling appears to be importantfor success.
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Support Program
Metformin therapy for prevention of type 2diabetes may be considered in :
those at highest risk for developing diabetes, such as thosewith multiple risk factors, especially if they demonstrateprogression of hyperglycemia (e.g. A1C 6%).
Monitoring for the development of diabetes inthose with prediabetes should be performedevery year.
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Macronutrients In
Diabetes Management
The best mix ofcarbohydrate,
protein, and fatmay be adjusted to
meet themetabolic goals
Monitoringcarbohydrate,
whether bycarbohydrate
counting, choices,or experience-
based estimation
Use of glycemic
index and glycemicload may provide amodest additional
benefit forglycemic control
Saturated fatintake should be
7% or less of totalcalories.
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Physical Activity In Diabetes
ManagementPeople with diabetes should be advised toperform at least 150 min/week of moderate-
intensity aerobic physical activity (5070% ofmaximum heart rate).
In the absence of contraindications, peoplewith type 2 diabetes should be encouragedto perform resistance training three timesper week.
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Dyslipidemia Screening
In most adult patients, measurefasting lipid profile at least annually.
Goals:
LDL cholesterol 100 mg/dl
HDL cholesterol 50 mg/dl
Triglycerides 150 mg/dl)
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Goals
Intensive lifestyle interventionresulted in
Average 8.6% weight loss
Significant reduction of A1C
Reduction in several CVD risk factors
Benefits sustained at 4 years
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Goals
A1C
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Correlation of A1C with
Estimated Average Glucose(eAG) Mean plasma glucose
A1C (%) mg/dl mmol/l
6 126 7.0
7 154 8.6
8 183 10.2
9 212 11.8
10 240 13.411 269 14.9
12 298 16.5
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